Jolie part of growing trend in tackling cancer

Diana Moglia Tully, a genetic counselor, poses with a chart showing the development of cancer in both sporadic and hereditary situations. According to Moglia Tully, patients who get hereditary cancer only account for 5-10 percent of patients who get the disease.

Published: Wednesday, May 15, 2013 at 6:07 p.m.

Last Modified: Wednesday, May 15, 2013 at 6:07 p.m.

Cancer genetic counselor Diana Moglia Tully has noticed more women making a bold choice when it comes to cancer. They are taking on the disease before they are even diagnosed.

"A lot more women are opting for preventive measures," said Tully, a new counselor at Ocala Regional Medical Center.

Tully has not started seeing patients yet in Ocala, since she just began work on May 1. But she has worked as a counselor in New York for several years, and in her experience, about half of patients elect to have preventive surgery.

This trend was highlighted Tuesday when actress Angelina Jolie announced she had undergone a double mastectomy because she tested positive for a gene mutation in BRCA1, a tumor suppressing gene, making her more susceptible to cancer. Then Wednesday, People magazine reported the star would have another surgery to remove her ovaries.

"Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much as I could," Jolie wrote in a Tuesday Op-Ed for the New York Times. The actress has a history of cancer in her family.

Patients with a BRCA1 mutation have, on average, a 65 percent risk of breast cancer in their lifetime, according to Stanford University's Cancer Institute's website. A BRCA2 mutation, on average, gives women a 45 percent lifetime risk for breast cancer and an 11 percent lifetime risk for ovarian cancer.

A BRCA2 mutation gives men a 6 percent chance of breast cancer, according to the institute.

The genetic counselor says more of her referrals are for breast and ovarian cancer, but testing can be done on both men and women for any type of cancers with a hereditary component.

Cancer genetic counselors see patients who have an increased risk of cancer due to a genetic mutation, such as BRCA1, or a family history, to determine if they should be tested. Patients can also be cancer survivors who are concerned about having cancer again, or are concerned about passing it on to their children through genetics.

Blood and saliva testing can both be used to obtain results in two weeks that would show how likely the patient is to develop cancer. Genetic testing can't detect all cases of cancer.

Tully recommends if there is a strong history of cancer in the family to start screening at age 25, or five to 10 years younger than the family member was when they found the cancer.

"For the most part, more than 95 percent of people we're going to catch if we started them at 25, if they have a gene mutation," Tully said.

But the majority of cancer is not hereditary, it's environmental. About 5 percent to 10 percent of cancer is hereditary, according to Tully. On average, 1 in 800 people has the mutation for BRCA, the tumor suppressor gene. This average rises to 1 in 40 Eastern European Jewish population.

If genetic results come back negative, which is more common, Tully and her patients talk about future risk. If the results are positive they will talk about those risks including surveillance like mammography and breast MRI, or surgery.

"Genetic counseling is brand new, it's a gap in our community," said Hayley Creasey, a registered nurse who oversees the oncology and general surgery service line at the Ocala Regional campus.

While the counseling is brand new to the hospital, testing has been available nationally since the mid-1990s, according to Tully.

Kate Robbins, 69, has a family tree with a strong history of cancer. She went for testing and, like Jolie, was positive for a BRCA1 gene mutation.

At 65, the Gainesville resident decided to have her ovaries removed. Cancer was discovered during the course of that preventive surgery.

"That surgery saved my life," Robbins said.

"Surgery is not the right choice for every woman," said Lisa Schlager, 46, vice president of community affairs and public policy at Facing Our Risk of Cancer Empowered, or FORCE, a Tampa-based nonprofit dedicated to individuals and families affected by hereditary breast and ovarian cancer.

"It really depends on the personality. It depends on your stage in life."

Schlager tested positive for BRCA1 mutation at age 31. She elected to have her ovaries and breasts removed.

"I have two little kids that need me," said Schlager, a resident of Washington, D.C. "I started to think about maybe I'd do more than just the ovaries. Every time I went for mammogram or breast MRI after that I felt I was a ticking time bomb."

The mother of two says being able to make that choice made her feel empowered.

<p>Cancer genetic counselor Diana Moglia Tully has noticed more women making a bold choice when it comes to cancer. They are taking on the disease before they are even diagnosed.</p><p>"A lot more women are opting for preventive measures," said Tully, a new counselor at Ocala Regional Medical Center.</p><p>Tully has not started seeing patients yet in Ocala, since she just began work on May 1. But she has worked as a counselor in New York for several years, and in her experience, about half of patients elect to have preventive surgery.</p><p>This trend was highlighted Tuesday when actress Angelina Jolie announced she had undergone a double mastectomy because she tested positive for a gene mutation in BRCA1, a tumor suppressing gene, making her more susceptible to cancer. Then Wednesday, People magazine reported the star would have another surgery to remove her ovaries.</p><p>"Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much as I could," Jolie wrote in a Tuesday Op-Ed for the New York Times. The actress has a history of cancer in her family.</p><p>Patients with a BRCA1 mutation have, on average, a 65 percent risk of breast cancer in their lifetime, according to Stanford University's Cancer Institute's website. A BRCA2 mutation, on average, gives women a 45 percent lifetime risk for breast cancer and an 11 percent lifetime risk for ovarian cancer.</p><p>A BRCA2 mutation gives men a 6 percent chance of breast cancer, according to the institute.</p><p>The genetic counselor says more of her referrals are for breast and ovarian cancer, but testing can be done on both men and women for any type of cancers with a hereditary component.</p><p>Cancer genetic counselors see patients who have an increased risk of cancer due to a genetic mutation, such as BRCA1, or a family history, to determine if they should be tested. Patients can also be cancer survivors who are concerned about having cancer again, or are concerned about passing it on to their children through genetics.</p><p>Blood and saliva testing can both be used to obtain results in two weeks that would show how likely the patient is to develop cancer. Genetic testing can't detect all cases of cancer.</p><p>Tully recommends if there is a strong history of cancer in the family to start screening at age 25, or five to 10 years younger than the family member was when they found the cancer.</p><p>"For the most part, more than 95 percent of people we're going to catch if we started them at 25, if they have a gene mutation," Tully said.</p><p>But the majority of cancer is not hereditary, it's environmental. About 5 percent to 10 percent of cancer is hereditary, according to Tully. On average, 1 in 800 people has the mutation for BRCA, the tumor suppressor gene. This average rises to 1 in 40 Eastern European Jewish population.</p><p>If genetic results come back negative, which is more common, Tully and her patients talk about future risk. If the results are positive they will talk about those risks including surveillance like mammography and breast MRI, or surgery.</p><p>"Genetic counseling is brand new, it's a gap in our community," said Hayley Creasey, a registered nurse who oversees the oncology and general surgery service line at the Ocala Regional campus.</p><p>While the counseling is brand new to the hospital, testing has been available nationally since the mid-1990s, according to Tully.</p><p>Kate Robbins, 69, has a family tree with a strong history of cancer. She went for testing and, like Jolie, was positive for a BRCA1 gene mutation.</p><p>At 65, the Gainesville resident decided to have her ovaries removed. Cancer was discovered during the course of that preventive surgery.</p><p>"That surgery saved my life," Robbins said.</p><p>"Surgery is not the right choice for every woman," said Lisa Schlager, 46, vice president of community affairs and public policy at Facing Our Risk of Cancer Empowered, or FORCE, a Tampa-based nonprofit dedicated to individuals and families affected by hereditary breast and ovarian cancer.</p><p>"It really depends on the personality. It depends on your stage in life."</p><p>Schlager tested positive for BRCA1 mutation at age 31. She elected to have her ovaries and breasts removed.</p><p>"I have two little kids that need me," said Schlager, a resident of Washington, D.C. "I started to think about maybe I'd do more than just the ovaries. Every time I went for mammogram or breast MRI after that I felt I was a ticking time bomb."</p><p>The mother of two says being able to make that choice made her feel empowered.</p><p>"I don't regret my decision one bit," Schlager said.</p><p><i>Contact April Warren at 867-4065 or April.Warren@ocala.com.</i></p>